multiple

health

SRS Instead of WBRT for Patients With Multiple Brain Metastases

Stereotactic radiosurgery (SRS) should replace whole-brain radiotherapy (WBRT) as the new standard of care for patients with four or more brain metastases, say researchers who report results from a randomized trial conducted in patients with four to 15 brain metastases

“SRS was associated with reduced risk of neurocognitive deterioration compared to WBRT, as demonstrated by a constellation of neurocognitive tests, individually or by composite scores,” said lead author Jing Li, MD, PhD, associate professor of radiation oncology and codirector of the Brain Metastasis Clinic at the University of Texas MD Anderson Cancer Center, Houston.

He was speaking at the American Society for Radiation Oncology (ASTRO) 2020 Annual Meeting, which was held online this year because of the COVID pandemic.

“The results from this phase 3 randomized trial strongly support the use of SRS in patients with four to 15 brain metastases to better preserve cognitive function and to minimize interruption of systemic therapy, without compromising overall survival,” said Li.

SRS is already the standard of care for patients with one to three brain metastases. Two previous phase 3 randomized trials showed that SRS was better at preserving cognitive function without compromising overall survival in comparison to WBRT.

However, there has been some controversy over the use of SRS for patients with multiple brain metastases, commented study discussant Sue S. Yom, MD, PhD, a professor in the Departments of Radiation Oncology and Otolaryngology–Head and Neck Surgery, University of California, San Francisco.

This study has shown “in a practice-changing manner that giving SRS can improve the quality of life of patients with metastatic disease,” she said.

Up to 30% of cancer patients develop brain metastases. Historically, these have been associated with poor overall survival, in the range of 1 to 4 months.

Reduces Cognitive Decline

The new trial involved 72 patients with four to 15 untreated, nonmelanoma brain metastases (up to 20 lesions were allowed at the time of treatment); the median number of brain metastases was eight. Most (83%) of the trial participants were White, nearly half were aged 60 years or older, and 58% were women.

Patients were randomly assigned to receive either SRS (15–24 Gy per Radiation Therapy Oncology Group protocol 9005) or WBRT (30 Gy in 10 fractions). On the basis of previous research, 62% of patients in the WBRT arm were also given memantine, a dementia drug that can help preserve cognitive function.

All participants completed neurocognitive testing, including testing of learning, memory, attention span, executive function, verbal fluency, processing speed, and motor dexterity, at enrollment and longitudinally.

The primary endpoints were Hopkins Verbal Learning Test – Revised Total Recall (HVLT-R TR) score and local control at 4 months. Secondary endpoints included overall survival, distant brain failure, toxicity, and time to initiation of systemic therapy.

In the primary endpoint analysis, at 4 months, the HVLT-R TR standardized z-score increased by +0.21 (standard error [SE], 0.27) for patients who received SRS, but it declined by –0.74 (SE, 0.36) for WBRT-treated patients (P = .041). On the basis

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health

Strive Health Partners with Nearly 200 Nephrology Providers Across Multiple States to Implement Innovative Medicare Kidney Care Program

Strive Health, a national innovator in value-based kidney care, today announced that it has partnered with nearly 200 physicians and advanced practitioners from 20 nephrology groups across several states to participate in Medicare’s Comprehensive Kidney Care Contracting options of the Kidney Care Choices model (CKCC).

CKCC is a new Center for Medicare and Medicaid Innovation (CMMI) payment innovation model that incentivizes healthcare providers to manage the care of Medicare beneficiaries with chronic kidney disease (CKD) stages 4 and 5 and end stage renal disease (ESRD). Unlike prior value-based kidney care models, CKCC addresses both CKD and ESRD beneficiaries and aligns patients based on nephrology care, not dialysis treatments. The implementation period for the program started on October 15, 2020 and the official launch of the performance period is on April 1, 2021.

“New payment models like CKCC are putting nephrologists at the center and creating meaningful opportunities to transform care for our patients,” said Gary Singer, MD, a nephrologist who leads Midwest Nephrology Associates in St. Louis, MO. “We looked for a partner whose incentives align with our goal of delaying the progression of kidney disease, and whose model blends technological innovation with high-touch care. We believe Strive is well-positioned to support us in CKCC and beyond.”

Strive Health provides technology, high-touch care teams, and management expertise that empower nephrologists to participate and succeed in new value-based kidney care models. Physicians partnering with Strive gain access to advanced tools and resources that improve care delivery, such as sophisticated data science models that predict CKD disease progression with greater than 95% accuracy. Physicians also participate in performance-based incentive programs that reward high-quality and low-cost patient outcomes.

“Our company is the market leader in transformative, value-based kidney care. The new CMMI models take an exciting step in the right direction and create unprecedented opportunities for nephrologists to innovate and be rewarded for high-quality, long-term care goals over individual treatments,” said Chris Riopelle, CEO and co-founder of Strive Health.

Through partnerships with nephrologists and direct care arrangements, Strive manages thousands of complex CKD and ESRD patients in five states today and will be managing, or supporting the management of, more than 30,000 patients in 12 states by early 2021. The company is actively launching new value-based kidney care arrangements with commercial payors, health systems, and medical groups – most recently announced include Humana and Conviva Health – and engaging local nephrologists as central care providers within these models. Future growth plans include new application opportunities for CKCC and additional government programs.

About Strive Health

Strive Health is a national innovator in value-based kidney care and partner of choice for leading healthcare payors and providers. Through a unique combination of high-touch care teams, advanced technology, seamless integration with local providers, and next-generation dialysis services, Strive deploys an integrated care delivery system that supports the entire patient journey from chronic kidney disease (CKD) to end stage renal disease (ESRD). Strive partners with commercial and Medicare Advantage payors, Medicare, health systems, and physicians through

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fitness

Multiple sclerosis as the flip side of immune fitness

genetics
Credit: CC0 Public Domain

About half of the people with multiple sclerosis have the HLA-DR15 gene variant. A study led by the University of Zurich has now shown how this genetic predisposition contributes to the development of the autoimmune disease multiple sclerosis in combination with environmental factors. The decisive factor is the shaping of a repertoire of immune cells which—although they are effective in fighting off pathogens such as Epstein-Barr virus—also attack brain tissue.

Multiple sclerosis is an autoimmune disease that damages the brain and the spinal cord and often severely limits a person’s quality of life. It affects about 2.5 million people worldwide, most of them young adults. The cause of the disease is a complex interaction between genetic factors and environmental influences such as smoking or infections.

Genetic variation and viruses as risk factors

For almost 50 years now, it has been known that a gene variant called HLA-DR15 is strongly associated with multiple sclerosis (MS). This gene variant is responsible for up to 60 percent of genetic risk. If carriers of this common gene (about a quarter of the healthy population is HLA-DR15 positive) are also infected with the Epstein-Barr virus and have a symptomatic course of infection called Pfeiffer’s disease (also known as glandular fever or infectious mononucleosis), the risk of MS increases 15-fold.

UZH Professor Roland Martin, Head of the Department of Neuroimmunology and MS Research at the University Hospital Zurich, says: “There are therefore clear indications that the interaction between HLA-DR15 and infectious agents such as Epstein-Barr virus is significant for the development of the disease, even though the exact mechanisms behind this have not been understood until now.”

An interdisciplinary, international study led by Martin has now shown that the immune cells of people with HLA-DR15 recognize certain microbes—such as the Epstein-Barr virus—very effectively, but that this “fitness” can also lead to an undesired immune reaction against the person’s own brain tissue.

Individual training for immune cells

The gene products of HLA-DR15 control how the adaptive immune system shapes an immune repertoire that allows the body to recognize and fight pathogens. One of the locations of HLA-DR15 molecules is on the surface of white blood cells. There, they present protein fragments from bacteria, viruses and body cells to the T lymphocytes of the immune system.

The T lymphocytes—which later control the immune response—learn to distinguish between foreign proteins and the body’s own tissue. This individual training of immune cells takes place first in the thymus and then in the blood. Since there are many more possible pathogens than T lymphocytes, each T lymphocyte must be able to respond to many different antigens and probably also many different pathogens.

Identifying the fragments presented

The researchers first investigated which fragments HLA-DR15 captured and presented to the immune cells. To do this, they used two novel antibodies that recognize the two variants of HLA-DR15 that occur in MS patients with a very high level of specificity. They found that the HLA-DR15 molecules in the thymus mainly

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health

New Trump ad features multiple clips of president wearing mask

A new political advertisement for President TrumpDonald John TrumpMichigan court overturns absentee ballot extension Trump jokes he’ll ‘find a way’ to fire Gov. DeSantis if he loses Florida Biden hits Trump’s response to attempted kidnapping of Michigan governor: ‘What the hell is wrong with this guy?’ MORE includes several video clips of him wearing a mask while a narrator praises his administration’s coronavirus response. 

Joe BidenJoe BidenTrump jokes he’ll ‘find a way’ to fire Gov. DeSantis if he loses Florida Biden hits Trump’s response to attempted kidnapping of Michigan governor: ‘What the hell is wrong with this guy?’ Trump on if Biden wins: ‘Maybe I’ll have to leave the country’ MORE has no real plan to defeat the coronavirus. Just criticize, complain and surrender,” the television spot begins, according to advertising tracker AdMo. “When President Trump shut down traveled to China, Biden attacked him.” 

The ad then pivots, showing several short videos of Trump walking through various medical facilities, wearing a mask, with a team of doctors and aides at his side. 

“President Trump is leading attacking the virus head on, developing a vaccine in record time,” the narrator declares. “Rebuilding our economy under President Trump Way will be careful, but resolute.” 

Trump, who initially downplayed the efficacy on masks, was diagnosed with coronavirus earlier this month and has since recovered, White House doctors say. 

The president sparked backlash when he removed a mask he was wearing as he left Walter Reed National Military Medical Center, where he was receiving treatment for symptoms related to the virus, before walking into the White House. 

Leading U.S. health officials agree mask wearing and social distancing are the two most effective ways to slow the spread of the coronavirus. 

“These face masks are the most important and powerful public health tool we have,” Robert Redfield, the director of the Centers for Disease Control and Prevention (CDC), told Congress earlier this year. “And I will continue to appeal to all individuals in this country to embrace these face coverings. If we did it eight, 10, 12 weeks, we’d bring this pandemic under control. We have clear scientific evidence they work and they are our best defense.” 

Trump has broken with the CDC and members of his own coronavirus task force fighting the pandemic on several occasions.

At the same time, he has also sought to capitalize on the public’s trust in the word of the nation’s leading scientists; a Trump campaign ad released last week showed Anthony FauciAnthony FauciKey coronavirus model predicts nearly 80 percent rise in deaths by February The Hill’s Morning Report – Sponsored by Facebook – Trump combative, Biden earnest during distanced TV duel Health experts say ‘herd immunity’ strategy would kill thousands MORE, the nation’s leading infectious disease expert, saying “nobody could have done more” to control the virus in America than Trump.

Fauci later pushed back on that ad, saying he felt the Trump campaign was “harassing” him.

Trump has also mocked Democratic presidential

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